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Site Address: 25726 Fuhrman Rd, Acampo Record ID WP0042250 <br /> Date: 7/22/2021 <br /> PHOTO#2 Cement truck receipt. <br /> : <br /> 41 f <br /> ORDER NUMBER: 55020 <br /> TICKET NUMBER: 1679578 <br /> w Ienver.Coal -, ;aq_, iJ_; 13'1 CYDS DEL: 6.1x1 <br /> r _ .SQ 2t FIrSti F.O. BO'? F::::, _ .. ktcn, !::, G�° LOAD a: 1 <br /> TRUCK 1D DRIVER PLANT ID LEAVE PLANT ARRNE 108 START POUR END POUR T LEAVE JOB A <br /> 550391643 F.UGY LADIUP,0, 06 Lor&BLocK PREvlousrnUG';"'" <br /> i CUSTOMER ACCT ID CUSTOMER P.O./PROJECT NO. PROJECT NAM <br /> 378099 / <br /> SOLD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED] Ch'[k <br /> /ALLEY DRILLING VALLEY;25726 FUHRMAN RD <br /> ACAMPO <br /> ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOL <br /> C/S COLLIER RD,PREPAID CC <br /> BEGINNING ENDING TOTAL <br /> Qty this Load Qty Ordered: QtYDIVd Product Code Product Description UOM Unit Price E%Tp�iRt <br /> 6.00 6.00 51; 10.3 SK. SAND SLURRY yd 157.50 945.00 <br /> ' „jars EME.7- ?:::V FREIGHT SURCIii:R E CY10.010 60'00 <br /> WATER ADDED/ESTIML TED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES I SUS TOTAL 1.005'00 .K <br /> Full Load. <br /> 2/3 Load: GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $77.89 <br /> GALSLUMP rate per minute for orders exceeding five 15)minutes per I ADDITIONAL TIME FEE TICKET ToTAr $1,082.89 <br /> 1/3 Load: GAL SLUMP(cubic yard. GRAND TOTAL:: $1,082.89 <br /> DESIGN SLUMP REQUESTED SLUMP I ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS ANDCONDITIONS ON SITE <br /> 4.00 7,00 <br /> Signature: Printed Name: <br /> USE OF CONCRETE,AS PLACED: RELEASE:Contractor or Owners agree to indemnify and save harmless Knife River Corporation from ility imposed as a <br /> result of any damage caused to the property of others as a result of su2b delivery.FOR ADDITIONAL R(EASE <br /> INFORMATION:SEE WIVW.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWW.P65WARNINGS.CA.Grrss.j'q-� <br /> TESTED BY AIR/SLUMP/TEMP/CPL'S <br /> V�ti <br /> Signature: Printed Name: <br /> Knife River Weighmaster Certificate <br /> THIS IS TO CERTIFY that the following described commodity was weighed, measured Or Counted by a weighmaster, <br /> whose signature is on the certificate, who is a recognized authority cf accuracy, as prescribed by Chapter 7 <br /> (commencing with, section 127001 of Division 5 of the California Business and Professional Ccde, admini <br /> the Division of Measurement Standards of the California Department of Fccd and Agriculture. stered by <br /> De ut <br /> Truck Driver User Disp Ticket Num Ticket ID Time Date <br /> 550341643 563397 user 1679578 34187 10:35 7/22/21 <br /> Load SizeMix Code Returned Qty Mix Age Seq Load ID <br /> 6,00 CYD_c 504 D 35836 <br /> Material YPEII Design Ory Required Satched %Var%Moisture Actual Wat <br /> YPEII968 Ib 5808 Ib 5820 lb 0.21% <br /> 7 -V 1935 Ib 12220 I6 12240 Ib 0.17% 5.25%A <br /> SAND 50.0 gI M 226.9 gl 228.0 gl 0.51%, 73 gl <br /> WATER 228.0 91 <br /> Num Batches: i <br /> Acual 1g960 Ib Design WIC: 0.430 Water/Cement. 0.431 A Design <br /> Load 7 00 in q Water in Truck: 0.0 g1 Adjust Water 0 0 300.0 gl Actual 301.3 gl To Add: 0.0 91 <br /> Slump. 911Load Trim Water 00 gIICYDE <br /> Page 2 of 2 <br /> Daria Afonskaia, Registered Environmental Health Specialist <br />